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Health Care Fraud Legal Defense for the San Diego Area

The Oberheiden & McMurrey, LLP is a health care law defense firm with significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Among our attorneys are the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, former lead prosecutors of the elite Medicare Fraud Strike Force, and other talented attorneys with years of relevant experience and education from the country’s top schools such as Harvard Law School and Yale Law School. Our attorneys routinely serve clients in San Diego as well as throughout California State.

If you’re in San Diego, California and you’re being investigated for health care fraud defense, call Oberheiden & McMurrey, LLP. We provide health care fraud defense strategies. We have extensive legal experience with OIG and grand jury subpoenas, Medicare and Tricare audits, fraud allegation defense, internal investigations, compliance programs, qui tam defense, protection of assets, criminal defense, and with federal jury trials. Our Health Care Fraud Defense Team includes a former Chief Health Care Fraud Coordinator for the U.S. Attorney’s Office, several former health care fraud prosecutors, elite former lead prosecutors of the Medicare Fraud Strike Force, and accomplished lawyers with leading education from some of the country’s best law schools, including Yale and Harvard.

If you’re being investigated for health care fraud, call Oberheiden & McMurrey, LLP and ask to speak with a member of our Health Care Fraud Defense Team. Calls are confidential and free of charge.

San Diego, California Is Monitored for Health Care Fraud

San Diego, California is one of nine areas in the United States that is monitored directly by the Medicare Fraud Strike Force for instances of health care fraud. This elite team of prosecutors and investigators is made up of members from various federal agencies, including the Department of Justice, Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. However, this list isn’t all-inclusive. Other agencies may have representatives who are members of the Medicare Fraud Strike Force.

San Diego, California and the surrounding areas are closely monitored because a large number of residents use a federal health care program. The number of people who are beneficiaries of a federal health care program increases the number of claims filed with the federal government. This leads the government to aggressively monitor, investigate, and prosecute allegations of health care fraud. In 2016, the Department of Justice investigated more than 300 cases. Around 80 of those centered on individual health care providers. The rest of the cases involved a health care entity or business. The agency reported that it recovered more than $900 million in fraudulently paid out claims.

What Is Health Care Fraud?

Federal health care fraud is defined as an attempt to obtain reimbursement for medical services or equipment from a federal health care program, such as Medicare, Medicaid, Tricare, or federal workers’ compensation, by filing fraudulent claims. It includes a violation of at least one of the following:

The Anti-Kickback Statute. Federal health care law prohibits kickbacks in exchange for referrals. Any individual (including doctors, marketing representatives, and business owners) may face prosecution for violating the Anti-Kickback statute for offering or providing payment or other valuables in return for patient referrals.

Stark Law. Stark Law is also known as the Self-Referral Law. It prohibits doctors from referring patients to specific health care service entities if the doctor (or a member of the doctor’s immediate family) has an ownership or investment interest, or if there is a compensation arrangement. However, there are statutory exceptions to this law.

False Claims Act. If you submit a claim to Medicare or any other federal health care program, you must abide by the False Claims Act. If the claim submitted to the federal government is inaccurate, the federal government may launch an investigation into your billing practices under the criminal provisions of the False Claims Act.

Prescription Fraud. The federal government keeps a close eye on health care practices that have an unusually high number of narcotic prescriptions. If you’re suspected of running a “pill mill,” you may be investigated for insurance fraud and for violating DEA dispensing rules.

Billing Fraud. The federal government investigates the upcoding of claims. Upcoding means that the next higher code is used for a service when the billing is done. The federal government will also investigate phantom billing (billing for services not provided), billing for patients who don’t exist (referred to as ghost patients), and billing for equipment or services that are not medically necessary.

Certification Errors. The federal government closely watches the home health care and hospice industry. The most common allegation includes fraudulent certification for home health care and hospice care.

Oberheiden & McMurrey, LLP is proud of its track record of success in helping clients avoid criminal charges. If you or your health care practice or business are being investigated for health care fraud in San Diego, California and the surrounding areas, call us right away. The phone call is free and confidential.

Health Care Fraud Includes Civil and Criminal Penalties

Allegations of health care fraud can in result in civil or criminal charges and penalties. Civil penalties may include civil repayment, non-payment of future claims, and you may be excluded from federal health care programs. Criminal penalties may include criminal prosecution, federal prison time, and fines that cost you hundreds or thousands of dollars.

If you are found guilty of criminal health care fraud, you may receive a prison sentence:

Up to 10 years for each count of health care fraud

Up to 20 years for each count of fraud that resulted in serious bodily injury to the patient

Life sentence if the health care fraud resulted in the death of a patient

One of the most common questions we are asked is what the worst-case scenario is for San Diego, California health care fraud. Determining whether you may face criminal prosecution or receive a federal prison sentence can depend on many factors, such as the severity of the injury suffered by the patient (if any), the interest of the federal prosecutor, and the reason why the investigation was pursued by the federal government. Oberheiden & McMurrey, LLP is ready to help you with your health care fraud defense case. Call us now. Initial consultations are free and confidential.

Determining If Your Investigation Is Civil or Criminal

Health care fraud investigations may be civil or criminal in nature. Oberheiden & McMurrey, LLP provides early intervention and custom defenses to help our clients avoid criminal charges. Call us immediately if you’re being investigated in San Diego, California or the surrounding area.

At the beginning of most health care fraud investigations, most clients are unsure whether they are facing civil or criminal charges. The U.S. Attorney’s Office has two divisions: One is civil and one is criminal. There are prosecutors who are employed for each division. Just because you’ve been contacted by a federal prosecutor doesn’t necessarily mean that you’re going to face criminal charges. The same is true regardless of which federal agency prosecutor contacts you. We can help you by contacting the federal prosecutor on your behalf to determine if your charges are civil or criminal. It is important that you keep in mind that a civil investigation can morph into a criminal matter if it isn’t properly defended. That’s why it is so important that you call Oberheiden & McMurrey, LLP right away if you’re contacted by a federal prosecutor.

Determining the nature of the case can depend on the legal interpretation of many things, such as OIG subpoenas, the manner in which the inquiry is made or in the way in which the allegations are made, and other indicators of criminal prosecution. Criminal prosecution may be signaled by search warrants, seizure warrants, arrest warrants, target letters, involvement of federal criminal prosecutors, IRS involvement, or grand jury subpoenas.

If you have questions about whether you are facing criminal or civil charges, contact Oberheiden & McMurrey, LLP right away. We represent individual providers, entire health care systems, and other related businesses. We provide health care defense services to individuals, businesses, and entities in and around San Diego, California being investigated by the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, Drug Enforcement Administration, Office of Inspector General, Medicare Fraud Control unit, San Diego or California state law enforcement, or the IRS.

Health Care Fraud Defenses for Clients in San Diego

Oberheiden & McMurrey, LLP provides health care fraud defense to clients in and surrounding San Diego, California. Many of our lawyers have previous experience as health care auditors and health care fraud prosecutors with the Department of Justice. We provide their extraordinary insight to our clients.

Immediate intervention for our clients. Our main goal for each client is to help them avoid criminal charges. Our experience and track record prove that the best way to defend against criminal prosecution is to intervene early and not give the government a lot of uninterrupted time to build its case against you. We constantly work to protect your freedom and your professional aspirations. Usually, we can get answers to the most important questions within just a few hours:

What is the investigation about?

What is the purpose of it?

How long will the investigation take?

What is the most likely outcome?

Challenging the government’s evidence. The Constitution requires the federal government to prove beyond a reasonable doubt that you acted with criminal intent. We test this high standard in each and every case where the federal government indicates that there may be criminal charges involved. Prosecutors often point to billing inaccuracies to attempt to prove criminal intent. However, we know from experience that mistakes happen, and that those mistakes do not and should not equate to fraudulent activity. Oberheiden & McMurrey, LLP has provided successful legal defense for clients across the United States by proving that the inaccuracies in billing are results of organization or human error and did not happen because of an intent to defraud the government. In our experience, we’ve noted that the use of unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the constantly changing laws and rules that are involved in health care are the most common errors that cause these investigations. Although these issues should be corrected, they should not lead to criminal liability.

Compelling and strategic defenses. We have the experience required to develop compelling and strategic defenses for each client. This includes locating applicable defenses and statutory loopholes. Many of our cases have been successful because of our use of legal exceptions. For instance, in the context of Stark Law which involves medical necessity certifications, we’ve been able to use exceptions to either mitigate or entirely resolve a health care fraud case.

Protecting your reputation. Oberheiden & McMurrey, LLP is about more than just defending you in the courtroom. We’re also here to help protect your professional reputation. Rightfully, many of our clients are concerned about how these allegations will affect their future. The media has the power to tarnish someone’s image or spread rumors. Reports are often biased and don’t always include the whole story. Our attorneys routinely address concerns about slander, and book news spots and other opportunities to correct misinformation about our clients.

Oberheiden & McMurrey, LLP has provided legal advocacy for clients all over the nation. Call us right away if you’re being investigated for health care fraud defense. The call is free and confidential.

Our Track Record

The commitment of Oberheiden & McMurrey, LLP is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former health care prosecutors and experienced defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home health care entities, and many other health care organizations against any form of alleged health care fraud. Here are some recent examples of our case outcomes.

Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.Result: No civil or criminal liability.

Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.Result: No civil or criminal liability.

Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.Result: No civil or criminal liability.

Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.Result: No civil or criminal liability.

Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.Result: No civil or criminal liability.

Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.Result: No civil or criminal liability.

Representation of a Health Care Services Company against an Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for Alleged False Claims Act and Stark Law Violations.Result: No civil or criminal liability.

Representation of a Health Care Marketing Group Against an Investigation by the Office of Inspector General for Alleged Health Care Fraud.Result: No civil or criminal liability.

Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.Result: No civil or criminal liability.

Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.Result: No civil or criminal liability.

Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.Result: No civil or criminal liability.

Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.Result: No civil or criminal liability.

Representation of Health Care Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.Result: No civil or criminal liability.

Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.Result: No civil or criminal liability.

Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.Result: No civil or criminal liability.

Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.Result: No civil or criminal liability.

Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.Result: No civil or criminal liability.

Health Care Fraud Defense Attorneys Serving San Diego, CaliforniaNick Oberheiden has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, during accusations of political corruption, government investigations, and directed media campaigns, including 60 Minutes. In addition to his health care defense practice, Dr. Oberheiden leads internal investigations, implements corporate compliance programs, and teaches U.S. criminal law and federal litigation in the United States and abroad.

Lynette S. Byrd is a former Assistant United States Attorney (AUSA). Clients greatly benefit from Ms. Byrd’s experience from the Department of Justice, where she prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Ms. Byrd has immense experience with health care law enforcement, and she regularly argues federal matters for her clients.

We are available every day of the year. You can call us directly, complete our contact form, or email us directly.

This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.